Treatment and prevention - Migraine

There is currently no cure for migraines. But treatments are available that can help to ease the symptoms.

It can take time to work out the best treatment for you. You may need to try different types of medicines before you find the most effective one.

If you cannot manage your migraines using over-the-counter medicines, your GP may prescribe something stronger.

During an attack

Most people find that sleeping or lying in a darkened room is the best thing to do when having a migraine attack.

Others find that eating something helps. Some find that they start to feel better once they have been sick.

Painkillers

Many people who have migraines find that over-the-counter painkillers can help to reduce their symptoms. These include paracetamol, aspirin and ibuprofen.

They usually work best if you take them at the first sign of a migraine attack. This gives them time to absorb into your bloodstream and ease your symptoms.

Do not wait until the headache worsens before taking painkillers. By then it's often too late for the medicine to work.

Tablets you dissolve in a glass of water (soluble painkillers) are a good alternative. They're absorbed quickly by your body.

Suppositories are a better option if you cannot swallow painkillers because you feel sick. These are capsules that you insert into your bottom.

Taking painkillers

When taking over-the-counter painkillers, always:

• read the instructions on the packaging
• take the correct dosage

Children under 16 should not take aspirin without the guidance of a healthcare professional.

Aspirin and ibuprofen are also not recommended for adults who have a history of stomach problems. These might include stomach ulcers, liver problems or kidney problems.

Taking any type of painkiller often can make migraines worse. This is sometimes called a medicine overuse headache or painkiller headache.

Contact your GP if you need to use painkillers repeatedly or if over-the-counter painkillers are not working.

They may prescribe stronger painkillers or recommend using painkillers along with triptans.

Triptan medicines

If normal painkillers are not helping to relieve your migraine symptoms, you should contact your GP.

They may recommend taking painkillers along with triptan medicines. They may also prescribe anti-sickness medicine.

Triptan medicines are a specific painkiller for migraine headaches. They work by reversing the changes in the brain that may cause migraine headaches.

Widening blood vessels are believed to be part of the migraine process. Triptans cause the blood vessels around the brain to narrow (contract).

Triptans are available as tablets, injections and nasal sprays.

Common side effects of triptans include:

• tightness
• tingling
• flushing
• warm sensations
• feelings of heaviness in the face, limbs or chest

Some people also experience feeling sick, a dry mouth and drowsiness.

These side effects are usually mild and improve on their own.

Taking too many triptans can also lead to a medicine overuse headache.

You will have a follow-up appointment with your GP when you have finished your first course of triptans. This is so you can discuss how they worked and if you had any side effects.

If the medicine was helpful, treatment will usually be continued.

If it was not helpful or caused unpleasant side effects, your GP may prescribe a different type of triptan. How people respond to this medicine can vary.

Anti-sickness medicines

Anti-sickness medicines can also be used to treat migraine. These are called anti-emetics.

Your GP can prescribe these. They can be taken alongside painkillers and triptans.

Anti-sickness medicines work better if taken as soon as your migraine symptoms begin.

They usually come in the form of a tablet. They are also available as a suppository.

Side effects of anti-emetics include drowsiness and diarrhoea.

Combination medicines

You can buy combination medicines for migraine without a prescription at your local pharmacy.

These medicines contain both painkillers and anti-sickness medicines.

If you're not sure which one is best for you, ask your pharmacist.

It can also be effective to combine a triptan with another painkiller, such as ibuprofen.

Many people find combination medicines convenient.

But the dose of painkillers or anti-sickness medicine may not be high enough to relieve your symptoms.

If this is the case, it may be better to take painkillers and anti-sickness medicines separately. This allows you to control the doses of each.

Acupuncture

If medicines do not suit you or do not help to prevent migraines, you can try acupuncture.

A course of up to 10 sessions over a 5 to 8 week period may help.

Migraine clinic

If these treatments are not helping, your GP may refer you to a specialist migraine clinic for further investigation and treatment.

Treatment for pregnant and breastfeeding women

Limit migraine treatment with medicines when you're pregnant or breastfeeding.

Try to identify and avoid potential migraine triggers instead.

If medicine is essential, your GP may prescribe you a low-dose painkiller.

In some cases, anti-inflammatory medicine or triptans may be prescribed.

Contact your GP for advice.

Preventing migraine

There are ways you can reduce your chances of having migraines.

Identifying and avoiding triggers

The best way to prevent migraines is noticing the things that trigger an attack and trying to avoid them.

You may find you have a migraine after eating certain foods or when you're stressed. By avoiding this trigger you can prevent a migraine.

Find out more about possible migraine triggers

Keeping a migraine diary can help you identify possible triggers. It also helps to track how well any medicine you're taking is working.

In your migraine diary, record:

• the date of the attack
• the time of day the attack began
• any warning signs
• your symptoms (including the presence or absence of aura)
• what medicine you took
• when the attack ended

Medicines and supplements

Medicines are also available to help prevent migraines. If you have tried avoiding triggers but you're still having migraines you can try these medicines.

You may also be prescribed these medicines if you have severe migraine attacks, or if your attacks happen often.

Medicines used to prevent migraines

The following medicines can help help to prevent migraines.

Topiramate

Topiramate is medicine that was made to prevent seizures in people with epilepsy. It is now much more commonly used in migraine prevention.

It is usually taken every day in tablet form.

People with kidney or liver problems should speak with their GP before taking topiramate.

Topiramate can harm an unborn baby if taken during pregnancy. Topiramate can also reduce the effectiveness of hormonal contraceptives. Your GP should discuss alternative forms of contraception with you if you are prescribed topiramate.

Side effects of topiramate can include:

• decreased appetite
• feeling sick
• being sick
• constipation or diarrhoea
• dizziness
• drowsiness
• problems sleeping

Propranolol

Propranolol is used to treat angina and high blood pressure. It also prevents migraines.

It's taken every day in tablet form.

Propranolol is not suitable for people with:

• asthma
• chronic obstructive pulmonary disease (COPD)
• some heart problems

It should be used with caution in people who have diabetes.

Side effects of propranolol can include:

• cold hands and feet
• pins and needles
• problems sleeping
• tiredness

Amitriptyline

Amitriptyline is a medicine designed to treat depression. But it can also help to prevent migraines.

It's taken every day in tablet form.

Amitriptyline can make you feel sleepy. It's best to take it in the evening or before you go to bed.

Other side effects include:

• constipation
• dizziness
• a dry mouth
• difficulty peeing
• a headache

It may take up to 6 weeks before you feel the full benefit of the medicine.

Acupuncture

If medicines are not suitable or do not help your migraines, you could consider acupuncture.

Preventing menstrual-related migraines

Menstrual-related migraines usually happen from 2 days before the start of your period, to 3 days after.

These migraines are fairly predictable. It may be possible to prevent them using certain medicines.

Medicine treatments

The treatments that are recommended are:

• non-steroidal anti-inflammatory drugs (NSAIDs) - such as ibuprofen
• triptans - medicines that reverse the widening of blood vessels

You take these medicines as tablets 2 to 4 times a day from either the start of your period or 2 days before. You take them until your last day of bleeding.

Advice and support

There are some organisations that offer advice and support for people with migraines. One of these is the Migraine Association of Ireland - migraine.ie.